Why emr is a dirty word to many doctors

The software in question was an electronic health records system, or EHR, made by eClinicalWorks eCW , one of the leading sellers of record-keeping software for physicians in America, currently used by , health professionals in the U. Damning evidence came from a whistleblower claim filed in against the company.

But soon after he was hired, Delaney noticed scores of troubling problems with the system, which became the basis for his lawsuit. Prescriptions, some 30, of them in , lacked proper start and stop dates, introducing the opportunity for under- or overmedication.

The eCW system did not reliably track lab results, concluded Delaney, who tallied 1, tests for which they had never gotten outcomes.

The eCW spaghetti code was so buggy that when one glitch got fixed, another would develop, the government found. The user interface offered a few ways to order a lab test or diagnostic image, for example, but not all of them seemed to function. The software would detect and warn users of dangerous drug interactions, but unbeknownst to physicians, the alerts stopped if the drug order was customized.

The eCW system also failed to use the standard drug codes and, in some instances, lab and diagnosis codes as well, the government alleged. The case never got to a jury. Despite the record settlement, the company denied wrongdoing; eCW did not respond to numerous requests for comment. If there is a kicker to this tale, it is this: The U. Or we should say: You do. Which brings us to the strange, sad, and aggravating story that unfolds below.

It is not about one lawsuit or a piece of sloppy technology. Electronic health records were supposed to do a lot: make medicine safer, bring higher-quality care, empower patients, and yes, even save money. Boosters heralded an age when researchers could harness the big data within to reveal the most effective treatments for disease and sharply reduce medical errors.

Patients, in turn, would have truly portable health records, being able to share their medical histories in a flash with doctors and hospitals anywhere in the country — essential when life-and-death decisions are being made in the ER. KHN and Fortune spoke with more than physicians, patients, IT experts and administrators, health policy leaders, attorneys, top government officials and representatives at more than a half-dozen EHR vendors, including the CEOs of two of the companies.

By one measure, certainly, the effort has achieved what it set out to do: Today, 96 percent of hospitals have adopted EHRs, up from just 9 percent in But on most other counts, the newly installed technology has fallen well short.

Physicians complain about clumsy, unintuitive systems and the number of hours spent clicking, typing and trying to navigate them — which is more than the hours they spend with patients. Our investigation found that alarming reports of patient deaths, serious injuries and near misses — thousands of them — tied to software glitches, user errors or other flaws have piled up, largely unseen, in various government-funded and private repositories.

Compounding the problem are entrenched secrecy policies that continue to keep software failures out of public view. Plaintiffs, moreover, say hospitals often fight to withhold records from injured patients or their families. Indeed, two doctors who spoke candidly about the problems they faced with EHRs later asked that their names not be used, adding that they were forbidden by their health care organizations to talk. Says Assistant U. Though the software has reduced some types of clinical mistakes common in the era of handwritten notes, Raj Ratwani, a researcher at MedStar Health in Washington, D.

I think few would argue they have. That was the real missing piece. As Biden would tell you, the original concept was a smart one. The wave of digitization had swept up virtually every industry, bringing both disruption and, in most cases, greater efficiency. Stowed in steel cabinets, the records were next to useless. Nobody — particularly at the dawn of the age of the iPhone — thought it was a good idea to leave them that way. Bush and Barack Obama. KHN and Fortune examined more than two dozen medical negligence cases that have alleged that EHRs either contributed to injuries, had been improperly altered, or were withheld from patients to conceal substandard care.

For two days, the young lawyer had been suffering from severe headaches while a disorienting fever left him struggling to tell the operator his address. The multimillion-dollar system, manufactured by Epic Systems Corp. His results and diagnosis were delayed — by days, he claimed — during which time he suffered irreversible brain damage from herpes encephalitis.

The suit alleged the mishap delayed doctors from giving Ronisky a drug called acyclovir that might have minimized damage to his brain. Epic denied any liability or defects in its software; the company said the doctor failed to push the right button to send the order and that the hospital, not Epic, had configured the interface with the lab. Ronisky, 34, who is fighting to rebuild his life, declined to comment. Incidents like that which happened to Ronisky — or to Annette Monachelli, for that matter — are surprisingly common, data show.

And the back-and-forth about where the fault lies in such cases is actually part of the problem: The systems are often so confusing and training on them seldom sufficient that errors frequently fall into a nether zone of responsibility.

Critical or time-sensitive information routinely gets buried in an endless scroll of data, where in the rush of medical decision-making — and amid the maze of pulldown menus — it can be missed. Thirteen-year-old Brooke Dilliplaine, who was severely allergic to dairy, was given a probiotic containing milk. The year-old man was sent home in from a Dallas hospital infected with Ebola virus.

Though a nurse had entered in the EHR his recent travel to Liberia, where an Ebola epidemic was then in full swing, the doctor never saw it. Duncan died a week later. Bobby and Tara Dilliplaine hold a photo of daughter Brooke, who suffered complications when she was given medication she was allergic to. She later died of causes unrelated to the EHR issue. Many such cases end up in court. Typically, doctors and nurses blame faulty technology in the medical-records systems.

The EHR vendors blame human error. And meanwhile, the cases mount. In 13 percent of those cases, the mistake could have been fatal. The Pew Charitable Trusts has, for the past few years, run an EHR safety project, taking aim at issues like usability and patient matching — the process of linking the correct medical record to the correct patient — a seemingly basic task at which the systems, even when made by the same EHR vendor, often fail. At some institutions, according to Pew, such matching was accurate only 50 percent of the time.

Patients have discovered mistakes as well: A January survey by the Kaiser Family Foundation found that 1 in 5 patients spotted an error in their electronic medical records. Indonesia is seeking to issue electronic medical records rules this year The Ministry of Health Indonesia is targeting to complete the regulation of electronic medical records this year as a legal umbrella to integrate digital and conventional medical services. All Rights Reserved. Loading Comments Email Required Name Required Website.

Then it dawns on me. I have begun to feel that after they do the upgrade, and warn us a patch will be imminent in a few months, I need to immediately race to the hardware store and buy copious amounts of mud and tape. Perhaps you have tried to find ways to help the computer people know your group better, thereby making the upgrade less painful. Save your time, you would do better to push a watermelon through a straw.

I do not say this in an evil way, I simply state that the twain shall never meet. This is because two things that are so different have no opportunity to unite. Your computer people have a goal in mind-upgrade your system with the newest bells and whistles using the specter of Meaningful Use, CMS, and PQRS penalties as impetus to do so. When we all began this, we often swallowed these bitter changes to our world because there was a reward for doing so.

At the end of the year we received incentive checks and all the bad memories evaporated. Until the next year, and we then realized the incentives were less. Now we are doing the upgrades not because of the incentives, which are minimal for the pain, but to avoid being penalized in the upcoming years. More in this issue: Eyewear holder gives patients place to store glasses during eye exam. I used to have doctors jokingly tell me on a bad day that retirement was getting closer and closer.

I even had blank applications in my desk drawer. I personally have my retirement agent on speed dial. I am a big proponent of EMR for a number of reasons: medical legally especially if you have multiple clinic locations , patient medication reconciliation and ordering, communication instantly between other clinics around the country, the ability to e-mail registrations, etc. When we had the discussion about going to EMR, I was pushing and praying the doctors to let us get the clinic online.

After we got the initial start-up bugs worked out, the doctors would agree that it was a good thing for our office. While upgrades mean increased technology, and the theory is excellent, these changes come in the form of widgets, apps, and clicks. Doctors hate to click, drop down, and scroll. My doctors all have smart phones, and they drop down and click gleefully on their phones. Put them in a clinic with the same clicks and they bust a gasket.